Robert H. Choplin

Image-guided catheter drainage of the infected pleural space.

Thoracic empyema occurs at all ages and has reported mortality rates of 10% to 75%. Most authors agree that complete drainage of complicated effusions or organized empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. For initial tube drainage, a 26-F to 36-F chest tube traditionally has been inserted at the bedside. The results of this method of empyema evacuation have varied widely, with an overall cure rate reported to be 47%. Image-guided placement of smaller 8-F to 14-F catheters has been offered as an alternative therapy with an overall reported cure rate of 81% in 104 patients.

Epithelioid hemangioendothelioma of the superior vena cava: computed tomography demonstration and review of the literature.

A case is reported of a 79-year-old man with rapid onset of superior vena cava syndrome caused by an epithelioid hemangioendothelioma. Contrast-enhanced helical computed tomography showed a soft-tissue mass with punctate calcifications obstructing the superior vena cava and infiltrating adjacent fat. Epithelioid hemangioendothelioma is a very rare primary mesenchymal tumor of the superior vena cava that often presents with calcifications. It should to be added to the differential diagnosis of tumors of the anterior mediastinum.

Pneumothorax Complicating Enteral Feeding Tube Placement

Two cases are presented of pneumothorax complicating enteral feeding tube insertion. A previous report describing three similar cases is noted. Neurologically impaired patients appear to be particularly at risk for this complication, which may be encouraged by use of a guidewire during tube insertion. It is suggested that enteral feeding tubes in neurologically impaired patients be inserted under fluoroscopic guidance using a tube specifically designed for this purpose.

Thoracic complications in patients undergoing intraperitoneal heated chemotherapy with mitomycin following cytoreductive surgery.

The purpose of this study was to determine the incidence and severity of thoracic reactions in patients undergoing intraperitoneal heated chemotherapy (IPHC).

Pleural infections: a clinical-radiologic review.

Pleural space infection is a common disorder that may result from a wide variety of causes and is associated with a wide range of etiologic agents. The authors reviewed retrospectively records of 102 patients with discharge diagnoses of empyema and/or bronchopleural fistula. Chest radiographs and computed tomography closest to the time of initial diagnosis were evaluated separately. In 78 cases of empyema, the etiologies included primary pulmonary infections (49%), postsurgical (23%), traumatic (11.5%), intraabdominal pathology (5%), and unknown (11.5%). In 24 cases of bronchopleural fistulas, the etiologies were previous surgical procedures (37.5%), pulmonary infections (37.5%), traumatic (4%), and unknown (21%).

Case report. Aortic pseudoaneurysm with aortobronchial fistula: diagnosis with CT angiography.

We report the case of an 82-year-old man with a 12-month history of recurrent hemoptysis caused by an aortobronchial fistula. Twenty-five years earlier, the patient underwent placement of an aortic graft for aortic transection sustained in a motor vehicle accident. Chest radiography and bronchoscopy showed nonspecific abnormalities. We emphasize the role of CT angiography with 2D and 3D reconstructions for the diagnosis of and surgical planning for this rare but potentially lethal aortic postoperative complication.

Bronchogenic carcinoma: A survey of CT protocols for staging disease

RATIONALE AND OBJECTIVES To determine whether a standard computed tomographic (CT) protocol is used in the staging of lung cancer. MATERIALS AND METHODS A questionnaire was designed to determine what type of CT scanner is used, whether intravenous contrast material is used, how often the abdomen is scanned and at what level, and the section thicknesses used in scanning the chest and abdomen in patients with lung cancer. A total of 1,118 survey forms were mailed to members of the Society of Thoracic Radiology and to all community hospitals in the United States with at least 300 beds. RESULTS The authors received 520 responses (47%) to the 1,118 questionnaires mailed. Of these 520 responses, 140 were from society members, 256 were from hospitals with 300-500 beds, and 124 were from hospitals with more than 500 beds. One-half of hospital respondents used helical CT scanners. Significantly more society members used helical CT scanners (P < .001). Intravenous contrast material was used to opacify mediastinal blood vessels at 449 (86%) of 520 hospitals. Intravenous contrast material was used for liver scanning at 363 (82%) of 444 hospitals, but it was used less often at hospitals in the northeast region and by society members than at hospitals in other regions (P < .001). A mixture of section thicknesses was commonly used (252 [48%] of 520 responses) for scanning the chest; a thickness of 8-10 mm was used in scanning the abdomen at most hospitals (348 [78%] of 445 responses). CONCLUSION No CT protocol is consistently used for the examination of patients with lung cancer. Use of intravenous contrast material during chest or liver CT also is not uniform.

Chemical-shift MRI of exogenous lipoid pneumonia

Exogenous lipoid pneumonia results from the aspiration or inhalation of fatty substances, such as mineral oil found in laxatives or nasal medications containing liquid paraffin. We present standard and lipid-sensitive (chemical-shift) MR findings in a patient with histologically confirmed lipoid pneumonia. The loss of signal intensity in an area of airspace disease on opposed-phase imaging was considered specific for the presence of lipid. 14 refs., 3 figs.

Evaluation of PACS in ultrasonography.

We review our experience with a picture archiving and communication system to replace film in the ultrasound section of a clinical radiology department. The system includes three ultrasound units connected by a fiberoptic network via acquisition nodes to a central data management system, workstation, and optical jukebox. The system handles 80% of sonographic studies in the department. Image production, interpretation, storage, and retrieval are evaluated. Despite limitations, a picture archiving and communication system can be integrated into a functioning ultrasound section of an active radiology department with minimal disruption and promising results.

Gastric Perforation from Hepatic Artery Infusion Chemotherapy

Hepatic artery infusion chemotherapy may result in mucosal inflammation and ulceration, gastrointestinal hemorrhage, pancreatitis and catheter-related vascular injury. We report a patient who developed gastric perforation during hepatic artery infusion chemotherapy. The influence of variations of hepatic artery branching and catheter placement in producing this life-threatening complication is discussed.